Health care advocates said on Thursday that four insurers offering plans in the new federal marketplace discriminated against people infected with H.I.V. and AIDS by requiring them to pay high out-of-pocket costs for drugs to treat H.I.V., including generic medications.
Two groups, the AIDS Institute and the National Health Law Program, filed a complaint on Thursday with the Department of Health and Human Service’s Office for Civil Rights, saying that the insurers violated a provision in the new health care law that bars companies from discriminating against consumers because of their medical conditions. They said that the insurers subjected people infected with H.I.V. to restrictions on medications that most patients take daily to keep the virus in check.
“The companies are going out of their way to discourage people with H.I.V. and AIDS from enrolling in their plans — a blatantly illegal practice,” Wayne Turner, a staff attorney with the National Health Law Program, said in a statement.
The complaint claims that the four insurers — CoventryOne, Cigna, Humana and Preferred Medical — placed H.I.V. drugs on the highest payment tier for midlevel, or silver, plans on the federal health insurance exchange in Florida.
CoventryOne, for example, placed every H.I.V. drug, including generics, on the most restrictive tier, meaning that consumers were required to exhaust a $1,000 deductible and were then asked to contribute 40 percent toward the cost of their drugs, the groups said. Similarly, Humana requires that members spend their $1,500 deductible and then contribute 50 percent, they said. Many of the plans, the groups said, also placed other requirements on the drugs, like advance authorization by a doctor or a limit of a 30-day supply.
CoventryOne, which is owned by Aetna, did not respond to a request for comment, and Preferred Medical could not be reached for comment.
Karen Eldred, a spokeswoman for Cigna, said the company’s H.I.V. drug coverage was in line with accepted medical practice. She noted that Cigna, like many other insurers, offers an array of plans in the federal marketplaces, including some that offer more comprehensive coverage.
A spokesman for Humana, Alex Kepnes, also noted that patients have different plan options, with varying levels of coverage, and that drugs for other diseases like rheumatoid arthritis and multiple sclerosis were also placed on a high payment tier.
Insurers have been asking consumers to pay more for the most expensive so-called specialty drugs, a trend that only accelerated in the new marketplaces as insurers competed fiercely to keep premiums low. Patients with serious conditions, like cancer or rheumatoid arthritis, are finding that their pharmacy bills are skyrocketing. More.....http://www.nytimes.com/2014/05/30/business/four-insurers-accused-of-discriminating-against-people-with-hiv.html?_r=0